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2 senators are working across the aisle to address the mental health crisis


Mental health care in the U.S. has long been riddled with the same problems - not enough funding, not enough programs, not enough providers. And the pandemic has only worsened this crisis. Rates of depression and other mental illness have soared.

BILL CASSIDY: Everybody has a personal experience with somebody who has had serious mental illness.

CHANG: That is Republican Senator Bill Cassidy of Louisiana. He and his Democratic colleague, Senator Chris Murphy of Connecticut, are working together to renew a mental health reform bill in Congress.

CHRIS MURPHY: So Bill and I kind of found each other six years ago and developed, you know, what, at the time, was really the most comprehensive piece of mental health reform legislation that Congress had seen in a decade.

CHANG: That bill, which was signed into law in 2016, is set to expire this year. Now the two senators are working across the aisle to get Congress to reauthorize what they say is an improved version of the legislation. And this increasingly rare bipartisan partnership, well, Senator Cassidy says it emerged from a well-worn book.

CASSIDY: I was reading a book by Pete Earley called "Crazy," a journalist who had written about his son's travails with mental illness and in the criminal justice system. And, Chris, let me turn the story over to you.

MURPHY: Well, so I was interested in working on mental health but needed a partner. And I ran into an advocate on a bus who told me that I should call Bill Cassidy because he saw Bill Cassidy walking into a hearing the other day with this worn out, dog-eared copy of "Crazy." And that's what I did. I read the book first. I reached out to him. He had just gotten to the Senate. We found out that there's a lot of things that Bill and I disagree on.

CHANG: Yeah.

MURPHY: But we found out that this was something that we had both personal history with but, you know, deep passion for. And we were off and running.

CHANG: Well, this legislation that passed back in 2016, it does expire this upcoming September, so you do have a looming deadline to get it renewed. And I know that both of you want to make some improvements to this legislation. Tell me, Senator Murphy, how would your bill improve access to mental health services for kids?

MURPHY: Well, one of the things we do is just expand the amount of money that's available in these programs. But let me give you a specific example. There's a really good program that we started in the original bill where pediatricians can get a little bit of money to create a relationship with a mental health provider so that when a kid's in their office, they can immediately get that mental health provider on the phone for a consult while the kid's sitting in the room. That's been a big, successful program since we launched it five years ago.

CHANG: Yeah.

MURPHY: It means that a lot of kids don't slip through the cracks. We know, though, that a lot of kids get their primary care in schools because we have a lot of school-based health clinics. So in this version of the bill, we make that grant, but we increase the amount of money in that grant program, and then we make it available to school-based health centers as well.

CHANG: Yes. Senator Cassidy, I mean, I'm so curious because you are a physician as well. Do you feel that there's still a problem in our country's health care system where there's a real disparity between how we treat sort of physical conditions versus mental health conditions? We see them as two classes of problems and we treat one with more urgency rather than the other.

CASSIDY: Absolutely. There are parity laws in which you would treat mental illness the same as physical illness, but it's been really hard to get those laws enforced. Medicare does not provide parity for mental health services relative to physical services.

CHANG: If I may, Senators, I just want to turn now for a moment to what happened in Buffalo. Senator Murphy, where does the conversation on gun laws go from here? Because gun control laws aren't going to pass this current Congress. So how might you try to prevent what happened in Buffalo through mental health legislation? Can you?

MURPHY: Well, I think this is a really interesting but sensitive conversation. I do worry that we sometimes sort of move too quickly to label everybody that commits a violent crime as mentally ill. You don't have to be mentally ill in order to do something very violent. And in fact, you know, sometimes I worry that it sort of reinforces the stigma around mental illness to assume that there's an automatic connection. In fact, people who are mentally ill are much more likely to be the victims of crime than the perpetrators of the crime.

You know, you probably have to explain America's gun violence problem through some other prism than just mental health because we don't have, you know, more mental illness than other countries have, but we have a lot more of this violence. I just think we should be fixing the mental health system because it's broken - period - stop. Not because we expect that by fixing it, we're going to solve America's violence problems. That's my view. Bill probably has a little bit of a different take on it.

CHANG: Yeah. Senator Cassidy, I'd love for you to weigh in. How much of a tie-in is there between mental health legislation and trying to address gun violence in this country? What do you think?

CASSIDY: First, I agree with everything that Chris said. There's - more violence is on the mentally ill than the mentally ill commit. And most mentally ill people are not violent. But there is a subset who can commit heinous crimes. The Virginia Tech shooter comes to mind from about 15 years ago. But he was the first in kind of a series of people who were identified with serious mental illness who later did heinous crimes.

So the question is, how do you address it? Congress has been attempting to do so. For example, after the shooting at the school in Florida, where there was no coordination between sheriff's department, mental health officials and school officials. The children were just put out on the street because they were perceived to be - their conduct was not suitable for the school.

Congress put forward a bill which allowed that communication to occur and trying to fix that problem - and we did. And we've actually - before the pandemic, we're seeing a steady decrease in the number of mass shootings. The pandemic has changed everything. Now, I'm not saying the one in Buffalo is related to the pandemic, but clearly the number of people dying from overdoses and the number - the amount of domestic violence has increased after the pandemic started. So that social isolation is not good for anybody's health. It's certainly not good for someone who's already got a - perhaps a tendency towards a mental health issue to begin with.

CHANG: I am curious, you know, because we are talking about a worsening mental-health crisis in this country during this pandemic. Was there a moment for either of you that further clarified just how much of a mental-health crisis this country is in?

MURPHY: Well, I mean, for me, you know, it's my perspective as a parent. I've got, you know, a 13-year-old and a 10-year-old. And when they got back into school, you know, it was just stunning how many kids in a pretty high-performing school were in the middle of mental-health crisis and needed professional backup in order to deal with the number of kids who had been socially isolated, who were coming back with a lot of compounded mental-health issues. So as a parent watching kids struggle through this pandemic, that's given me a really unique and sometimes harrowing perspective.

CASSIDY: I think my perspective - we were having too many people dying from overdose. But before the pandemic, it had fallen from roughly 100,000 a year to about 60,000 a year. And then with the pandemic, it has risen back from 60,000 to 100,000. One-hundred-thousand Americans are dying annually from overdose. When I say that everybody has somebody that is connected to their family with serious mental illness, you can double that when it comes to people who've got someone battling addiction and/or who has died from addiction. So I think that was my kind of epiphany. My gosh, of course we got to reauthorize, but we got to do more.


CHANG: That was Republican Senator Bill Cassidy of Louisiana and Democratic Senator Chris Murphy of Connecticut discussing their mental health reform bill. Transcript provided by NPR, Copyright NPR.

Ailsa Chang is an award-winning journalist who hosts All Things Considered along with Ari Shapiro, Audie Cornish, and Mary Louise Kelly. She landed in public radio after practicing law for a few years.
Jonaki Mehta is a producer for All Things Considered. Before ATC, she worked at Neon Hum Media where she produced a documentary series and talk show. Prior to that, Mehta was a producer at Member station KPCC and director/associate producer at Marketplace Morning Report, where she helped shape the morning's business news.
Roberta Rampton is NPR's White House editor. She joined the Washington Desk in October 2019 after spending more than six years as a White House correspondent for Reuters. Rampton traveled around America and to more than 20 countries covering President Trump, President Obama and their vice presidents, reporting on a broad range of political, economic and foreign policy topics. Earlier in her career, Rampton covered energy and agriculture policy.